HomeMy WebLinkAboutDisabilty_Riedford;�
F�.: LIE6 7levi�cd 17i9 .. .
1'r+crib�d by Ihe Slnte .
❑�:rd af 7'nx (;omr..:ev!vncn " .
. - ��=�=y=0
�� A1�PIDEIVIT POlt I3LINll Olt ll1SA13L�ll PI:1tSON'S^�,��j�U ��l ��i
� 'i'0 llG h'ILIiD IY PliH50N Olt I3]" h1A1L P:ACII I'PA12 1VITH�TH�?��"—��—
� COUN7'Y AUllPt'Oli Uli'C14'lEN NARCII 1 ANU i1IAY 10, INCLUSIVli
FILING INl�'OR11A7'ION ON 13ACK <<���' g����
�Y✓'.z.li � !ry�S
.(� p��,,,�,� AUDI70R
STA'I'E � Ii��DI:1iQ?. .....C.1F--CI.�,l4�r..'......--.-_-- COUNTY, SS:
_ .. . . .. . .. . .. .. . _-. . ._.......���.......... ing duly sworn, on oath s.l,}�fl iI1iLL IIC OC Y}1C
be
resic!es at ........ ..............- -- ---- .. . ..
� - ..........- - - ......... -.-... -- ........ ....._.. . .. ........ - ......... .........,
Sizecc � � City � � � ' County .1�,1r� "°�D d
� �19 S. � r.A
❑ he or shc is a blinl per;ou (as defined in the Indiana Code 12-1-1-1-(0) ) ��^�'�� o� v�
Jndi:in�; th�it �-he or she is a disaLled persuu as defined in the Indiana Code G-3-3-G (n) (8) : Q�.
�
u�e�lil�g rea! estate whicli ia used and occupied principally fur hia or her residence, t111CI F.I11C II14 OC I7CP tRXBI)IC E;I'094
income (esclusive of any income not taxed under tlie federal income tas laws) is iiot in C%Cl'49 UI .`�p1,600 for the
iiumediately preceding calendar year.
'1'hat this uffidavit is made for the purpose'of ha��ing tiwo Uiousaud (�y2,000) dollars deducLed Irum the asscss-
ed valuaLion of the •fo�lbwi�g �e_�,sc �ifi i taxable property for the yeu 19../. � lu wit: ..... .. __......
........... ......
� ........................ ...... ���-�� .. . .... - -` � ...... .: . ......$�� �.3�._..........._
�ciug the applicant's pr,incipal,resitlence pursuuut to IC G-1.1-12-11 and 6-1.1-12-J,?,.
: �/ �
......... � �-..!a-%.�% ..............................�..................
.�% f�,y�j� %�u�S � pplicnnt
AUDITOR � ,/�� �.j�
Subsci�ibed and siyorn to Uefore me this _...........�_....._---.... da�� of ..........1..!.1......-- -... 19....!..�
,
..........���.�./�'� � . .....................
POIZ AUDITOIt'S USL
Toiid rissessed \'alue oi Takable Property for year 19..�. V
..............__.........._......�`I_i�"��......'............."' T0�5'i19I11�), Real �state ��--.....................................
. �'.Ol'j701'at10ll
:lssessed in the name of - -�..�A�.�.....�A1.1'�.....���.IJLP]!4/x2l.l.�' . ............... .......--............
O lJ
Amount ot Tasable Proper'ty Deducted � .....................-----.... Net Value of TaxaLle Yroperly $----.....................---�
1� iled ........ �J.. �.�1...-......- -...., 19�� -- ....�f'.l�l. V �.l- �- ....� .................
. ..Audi�� t•
•